Provider Demographics
NPI:1851672802
Name:CHITTIPROLU, CHANDRASEKHARAM
Entity Type:Individual
Prefix:
First Name:CHANDRASEKHARAM
Middle Name:
Last Name:CHITTIPROLU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2-73
Mailing Address - Street 2:
Mailing Address - City:RENTACHINTALA
Mailing Address - State:ANDHRA PRADESH
Mailing Address - Zip Code:522421
Mailing Address - Country:IN
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8033 E 10 MILE RD
Practice Address - Street 2:
Practice Address - City:CENTER LINE
Practice Address - State:MI
Practice Address - Zip Code:48015-1427
Practice Address - Country:US
Practice Address - Phone:586-427-5344
Practice Address - Fax:586-427-5589
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-05
Last Update Date:2011-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302035551183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist